To offer insights for enhancing the hierarchical medical system and guiding patient healthcare-seeking behaviors systematically, this study analyzes referral willingness and influencing factors of tertiary public hospitals and primary healthcare institutionsamong chronic disease patients in Sichuan Province.

A questionnaire survey was conducted on 297 chronic disease patients. Descriptive statistical analysis of the data was performed using SPSS 26.0 software. Chi-square tests were employed to analyze the downward referral willingness of chronic disease patients from tertiary public hospitals and the upward referral willingness to primary healthcare institutions.

Patients in large public hospitals showed low downward referral willingness (44.2%). Rural residence, prior medical consortium services, and greater distance from tertiary hospitals increased willingness. Primary healthcare patients exhibited a 28.1% upward referral willingness, influenced by occupation, age, and use of outpatient special disease policy services.

Referral willingness is generally weak in large public hospitals and primary healthcare institutions. Enhancing the comprehensive capacity of primary healthcare institutions, strengthening collaborative mechanisms and the level of medical services within medical consortia, along with expanding reimbursement policies for chronic diseases, contributes to promoting bidirectional patient referrals and advancing the formation of a tiered diagnosis and treatment system.